Successful Treatment Of Anemia Research Articles

Successful Treatment of Anemia with Roxadustat in a Hemodialysis Patient Following Erythropoietin-Induced Pure Red Cell Aplasia

Successful Treatment of Anemia with Roxadustat in a Hemodialysis Patient Following Erythropoietin-Induced Pure Red Cell Aplasia

Assessment of the impact of anemia on hematological parameters among hemodialysis patients with chronic kidney disease

Anemia is a common consequence of chronic kidney disease (CKD) that is linked to a decrease in patients' quality of life, a rise in morbidity and mortality, and an acceleration in CKD progression. This study aimed to investigate the hematological profile of chronic renal patients undergoing hemodialysis and to correlate the same with anemia. Fifty (54% males and 46% females) with ages ranging from 18-76 years of patients with CKD and on regular maintenance hemodialysis not less than three months at the Iraqi center for dialysis in Baghdad teaching hospital, and 30 healthy adults were recruited into the study. Hemoglobin concentration, red cell count, white blood cell count, platelet count, ESR, CRP and HCV were assessed for the subjects and controls. Results were analyzed using a t-test independent, and the data were retrieved from the laboratory information system in the hospital. Red blood cell count was reduced in nearly all (96%) of the study patients, while ESR was elevated in (98%) and CRP was elevated in (95%). All patients suffered anemia in HD patients. Most of the patients' WBCs and platelet counts were normal. Anti-HCV antibodies were positive in 15 (30%) of these patients, with non-significant differences in both genders. The study concludes that anemia is a significant comorbidity in hemodialysis patients, with several factors contributing to it, and thorough workup and successful treatment of anemia are essential in this group of patients. Keywords: Anemia; Hematological profile; Hemodialysis; Hepatitis; chronic kidney disease

The impact of response to iron therapy on maternal and neonatal outcomes among pregnant women with anemia

Anemia during pregnancy is associated with increased risks of preterm birth, preeclampsia, cesarean delivery, and maternal morbidity. The most prevalent modifiable cause of pregnancy-associated anemia is iron deficiency. However, it is still unclear whether iron therapy can reduce the risks of adverse outcomes in women with anemia. This study aimed to determine whether response to iron therapy among women with anemia is associated with a change in odds of adverse maternal and neonatal outcomes. This was a population-based cohort study (2011-2019) using an institutional database composed of obstetrical patients from 2 delivery hospitals. Patients with adequate prenatal care were classified as being anemic or nonanemic (reference). Patients with anemia were further stratified by success or failure of treatment with oral iron therapy using the American College of Obstetricians and Gynecologists criteria for anemia at the time of admission for delivery: successfully treated (Hgb≥11 g/dL) or unsuccessfully treated ("refractory;" Hgb<11 g/dL). All categories of women with anemia categories were compared with the reference group of women without anemia using chi-square and logistic regression analyses. The primary outcomes were preterm birth and preeclampsia. Among the 20,690 women observed, 7416 (35.8%) were anemic. Among women with anemia, 1319 (17.8%) were refractory to iron therapy, 2695 (36.3%) had a successful response to therapy, and 3402 (45.9%) were untreated. Successfully treated patients with anemia had a significant reduction in the odds of preterm birth (5.1% vs 8.3%; adjusted odds ratio, 0.59; 95% confidence interval, 0.47-0.72) and preeclampsia (5.9% vs 8.3%; adjusted odds ratio, 0.75; 95% confidence interval, 0.61-0.91). Refractory and untreated patients had significantly increased odds of preterm birth (adjusted odds ratio, 1.44 [95% confidence interval, 1.16-1.76] and 1.45 [95% confidence interval, 1.26-1.67], respectively) and preeclampsia (adjusted odds ratio, 1.54 [95% confidence interval, 1.24-1.89] and 1.44 [95% confidence interval, 1.25-1.67], respectively). All groups of women with anemia had increased odds of postpartum hemorrhage and decreased odds of delivering a small for gestational age neonate. There was no difference in composite neonatal morbidity. Successful treatment of anemia with oral iron therapy was associated with a reduction in the odds of preterm birth and preeclampsia. Women with refractory anemia had similar outcomes to those who were untreated, emphasizing the importance of monitoring response to iron therapy during pregnancy.

Successful Treatment of Anemia With Anaplastic and Microangiopathic Characteristics in a Kidney Transplant Recipient With Parvovirus B19 Infection: A Case Report

BackgroundThe prevalence of parvovirus B19 infection in renal transplantation ranges from 2% to 30%. The age and immune status of the patient influence the severity of the clinical picture. A diagnosis is made by taking as evidence the giant proerythroblasts on a bone marrow sample and the parvovirus B19 viral replication with a polymerase chain reaction (PCR) technique at the blood level. Clinically, parvovirus B19 may appear with fever and severe anemia, which can be followed by pancytopenia and thrombotic microangiopathy in some cases. The literature reports a graft dysfunction rate ranging from 10% to 36%. An infection relapse may happen in 30% of cases. Case presentationWe report the case of a 33-year-old patient who underwent a kidney transplant in January of 2018. After transplantation, he reached a creatinine value of 1.1 mg/dL and a hemoglobin (Hb) level of 14 g/dL. In April 2019, he developed mycoplasma pneumonia, with signs of hemolytic anemia on bone marrow aspiration. Eventually, he was admitted because of fever, arthralgia, and anemia, with serologic and bone marrow biopsy evidence of red cell aplasia secondary to parvovirus B19 infection. He was treated with 400 mg/kg intravenous immunoglobulin (IVIg) for 10 days; 18 days after the end of treatment, he reached a creatinine value of 1.15 mg/dL, an Hb of 12.5 g/dL, and a reduction of the viral load from 25,000,000 copies/mL to 1,600,000 copies/mL. ConclusionsAnemia with both an aplasic and hemolytic component was successfully treated using immunoglobulin therapy, with a significant fall in the parvovirus B19 viral load.

Refractory Anemia with Ring Sideroblasts Associated with Marked Thrombocytosis Complicated by Massive Splenomegaly Treated with Lenalidomide Resulting in Resolution of Splenomegaly but Severe and Prolonged Pancytopenia

Refractory anemia with ring sideroblasts associated with marked thrombocytosis (RARS-T) is a hematological malignancy that combines features of both a myeloproliferative and myelodysplastic disorder. There have been recent reports of the successful treatment of anemia in 2 patients with RARS-T with lenalidomide. Here we report the successful treatment of massive splenomegaly in a patient with a long history of RARS-T resulting in complete resolution of splenomegaly, but with prolonged severe cytopenias. We also report the acquisition of the t(3;12)(q26;p13) translocation previously described in cases of myelodysplasia and the potential for transformation to myelofibrosis.

Lack of expression and function of erythropoietin receptors in the kidney

Erythropoiesis-stimulating agents (ESAs) stimulate formation of red blood cells by binding to and activating Epo receptors (EpoR) on erythroid progenitor cells. Beyond successful treatment of anemia, ESAs have been reported to reduce damage following insult to organs, including the kidney, possibly via direct activation of EpoR. However, data on ESA effects outside hematopoietic functions are conflicting. Furthermore, limited use of appropriate EpoR-positive and EpoR-negative controls and lack of specific anti-EpoR antibodies make interpretation of data difficult. Recently positive and negative control cell types were validated and a sensitive and specific anti-EpoR antibody (A82) that detects low levels of EpoR protein was described. A82 was used to measure EpoR protein levels in tissues, human renal cells and human cell lines by western blot analysis. Surface EpoR was examined on renal cells by measuring binding of [125I]-rHuEpo or antibodies. Renal cells and cell lines were treated with rHuEpo to see if phosphorylation of signaling proteins or proliferation/survival could be induced. Small inhibitory RNA (siRNA) were used to determine if EpoR knockdown affected cell viability. Total EpoR protein was low to undetectable in tissues and renal cells with no detectable EpoR on cell surfaces. EpoR knockdown had no effect on viability of renal cell lines. RHuEpo had no detectable effect on intracellular signaling on renal cell lines with no growth-promoting or survival effect on primary human renal cells. These results suggest that functional EpoR protein is absent on renal cells and that non-EpoR mechanisms should be explored to explain non-hematopoietic effects of ESAs.

IRON DEFICIENCY ANEMIA

t r o d u c t i o n : The adherence to treatment of iron deficiency anemia often is poor in both developed and developingcountries. The current standard therapy is oral ferrous sulfate administered 3 times daily. It is possible that adherence would improve witha single-dose daily treatment regimen. O b j e c t i v e s : To compare single versus thrice daily ferrous sulfate for treatment of iron deficiencyanemia in young children. D e s i g n : Quasi experimental study Setting: Children Department Military Hospital Rawalpindi. P e r i o d : From (01Jan- to31 Mar 05 and 03 Jul to 02 Oct 05) Subjects and Methods: Total 250 patients of iron deficiency anemia (hemoglobin values: 7.0to 9.9 gm/dl and serum ferritin values: 10 ng/ml or less) were identified. Children divided into two groups and matched on the basis of age;and gender. One group (n = 125) received ferrous sulfate once daily and the control group (n = 125) received ferrous sulfate thrice dailyat a total dose of 6 mg/kg/day of elemental iron for 2 months. Hemoglobin and serum ferritin values were measured as baseline and at theend of the study. R e s u l t s : Successful treatment of anemia (target hemoglobin &gt; 10 gm/dl) occurred in 81.42 % of the single dose and in79.83 % of thrice daily dose groups and the side effects were minimal between the two groups. Conclusion: A single versus a 3 times dailydose of ferrous sulfate resulted in a similar rate of successful treatment of iron deficiency anemia, without significant side effects.

Adherencia al Tratamiento de la Anemia con Fumarato Ferroso Microencapsulado

ABSTRACT Adherence to Treatment of Anemia with Microencapsulated Ferrous Fumarate Objective: To evaluate the adherence to treatment of anemia through the percentage of response withferrous fumarate, in comparison to ferrous sulfate drops after two months of treatment. Study Design:randomized controlled clinical trial. Intervention: ferrous sulfate drops and microencapsulated ferrousfumarate sprinkles. Methods: 128 Children (age 6-24 months) were enrolled and randomized to ferroussulfate drops group or ferrous fumarate group. Capillary blood samples taken at the baseline and final visitswere obtained from a finger prick in order to asses hemoglobin values. Compliance was also measured. Results: Successful treatment of anemia (hemoglobin > 13,6 g/dl) occurred in 54% of the sprinkles groupand in 22% of the drops group (p < 0,05). The positive response to treatment was higher in the experimentalgroup (91%) than the control group (71%) (p < 0,05). The rate of compliance was 55% in the control groupand 76% in the experimental group. The mean hemoglobin levels increases significantly in each group frombaseline to the final visit.

Restless Legs Syndrome (RLS) in anemic patients with Congestive Heart Failure and Chronic Renal Failure: Lack of effect of anemia treatment

Objective To assess the prevalence of Restless Legs Syndrome (RLS) in anemic patients with Congestive Heart Failure (CHF) and Chronic Renal Failure (CRF) and to evaluate the effect of anemia treatment on RLS. Methods 38 anemic CHF–CRF patients were treated with subcutaneous Erythropoietin (EPO) and intravenous (IV) iron over 1 year. They were questioned initially and at 3 months post treatment about symptoms of RLS according to standard criteria. They were also contacted by telephone about RLS symptoms 12 months after onset of anemia treatment. Results RLS was found in 15 (39.5%) of the 38 patients. In 10 (66.7%) patients it was present at least 6 days a week. The prevalence of the RLS initially was not related to Hb, to serum iron or % Transferrin Saturation. Diabetes and lower serum ferritin were more common in the RLS group ( p < 0.05). After 3 months of treatment, Hb increased from 10.4 ± 0.8 to12.3 ± 1.2 g/dl, but RLS symptoms did not change. By 12 months the prevalence and frequency of RLS complaints was similar to what it had been initially. Conclusion RLS is common and often undiagnosed and untreated in anemic CHF–CRF patients. Unfortunately, successful treatment of anemia with EPO and IV iron did not improve this condition.

Erythropoietin Use in Cancer Patients: A Matter of Life and Death?

It has now been 15 years since the first formal demonstration that recombinant human erythropoietin can ameliorate anemia associated with cancer. Since then, dozens of clinical trials in diverse groups of cancer patients have convincingly demonstrated the power of erythropoietin to increase hemoglobin (Hb) levels, and to reduce the need for potentially risky RBC transfusions. Three nonrandomized, community-based, open-label studies, enrolling more than 7,000 patients with nonmyeloid malignancy, and at least one randomized study, also suggested that erythropoietin can improve patients’ quality of life (QOL). A subsequent placebo-controlled study, however, indicated that this QOL benefit may be more modest than was initially hoped. Because recombinant erythropoietin is viewed by most clinicians as relatively nontoxic, and because erythropoietic agents are widely believed to have both objective and subjective benefits, the chief barriers to the universal use of this class of drugs have been relatively high cost, the lack of a uniform Hb response, clinical inertia, and patient inconvenience. In addition, there are several efficacy hurdles that, if cleared, could lead to a more robust recommendation for the use of erythropoietin in all patients with cancer: a clear demonstration that erythropoietin improves tumor response to therapy; an unequivocal demonstration that erythropoietin improves overall survival; and convincing evidence that erythropoietin therapy can benefit patients with normal or near-normal Hb levels, just as it helps those with moderate or severe anemia. Because improvement in overall survival is the gold standard for any drug treatment in people suffering from malignancy, trials were developed to try to demonstrate that recombinant erythropoietin could positively influence life expectancy in this group of patients. Improvement in cancer survival with erythropoietin therapy seemed a lofty goal but did not appear to be too much to ask. There was good reason to believe that successful treatment of anemia might augment the effectiveness of cancer therapy and prolong life, given that there is little question that the presence of moderate to severe anemia is associated with reduced survival in persons with a malignancy. It is less clear, however, whether anemia itself is the proximate cause of reduced survival or is instead a surrogate marker for other adverse prognostic features. Correction of Hb to near-normal levels with RBC transfusions might help clarify this question, but is not practical and has multiple potential toxicities. Thus, the possibility of improving survival by ameliorating anemia is best addressed by the use of recombinant erythropoietin. However, an important caveat with respect to erythropoietins is that the effects of this class of drugs on cancer outcomes from anemia correction alone may never be understood clearly because they appear to have biologic effects other than just increasing hemoglobin. Interest in a possible positive association between erythropoietin treatment and survival was fueled by a prospective, randomized, double-blind, allocation-concealed, multinational study of 375 anemic patients receiving chemotherapy for nonmyeloid cancer, which suggested a trend toward improved survival with erythropoietin use (median survival, 17 months with epoetin alfa, 11 months with placebo; Kaplan-Meier estimates, P .13, log-rank test). However, that study’s primary end points were transfusions, Hb response, and QOL; it was not powered to detect survival differences. A similar but also not statistically significant trend toward improved survival with erythropoietin was observed in the recently published, placebocontrolled epoetin alfa study of the North Central Cancer Treatment Group, which also enrolled anemic patients with nonmyeloid cancer receiving chemotherapy. Despite these two large trials and other smaller studies suggesting a potential survival benefit with the use of recombinant erythropoietin, a meta-analysis that included 19 studies in cancer patients (randomized trials published JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 23 NUMBER 25 SEPTEMBER 1 2005

Management of anemia in patients with cancer.

Anemia is extremely common in patients with cancer. Low hemoglobin levels are associated with diminished quality of life and possibly decreased overall survival. Successful treatment of anemia has undeniable benefits for patients, often yielding dramatic symptomatic improvement that can be very satisfying for clinicians to observe. This review focuses on evolving issues in the management of anemia in patients suffering from cancer. Topics addressed include new evidence-based guidelines concerning the use of epoetin alfa, the evolving role of darbepoetin alfa in cancer-associated anemia, the potential for concomitant iron supplementation to maximize response to erythropoietic agents, the unresolved question of whether erythropoietin use affects survival in cancer patients, new concerns about the risk of thromboembolism in cancer patients with higher hemoglobin levels who are receiving epoetin, and possible immunosuppressive effects of blood product transfusions that may have relevance to neoplasia progression.

Successful treatment of anaemia of nephrotic syndrome with recombinant human erythropoietin

Successful treatment of anaemia of nephrotic syndrome with recombinant human erythropoietin

Successful treatment of anaemia of nephrotic syndrome with recombinant human erythropoietin.

Successful treatment of anaemia of nephrotic syndrome with recombinant human erythropoietin.

Blood Lactate Is Reduced following Successful Treatment of Anaemia in Haemodialysis Patients with Recombinant Human Erythropoietin both at Rest and after Maximal Exertion

The effect of increasing haemoglobin by erythropoietin therapy on exercise capacity was investigated in 11 regular haemodialysis patients, previously transfusion dependent. Exercise work load increased from a median of 100 W (95% confidence limit, 25-135) to 120 (45-180; p < 0.05) following erythropoietin, and the duration of the exercise test from 13 (3.5-20) to 15.5 min (4-22; p < 0.05). Resting blood lactate concentration decreased from 0.8 (0.6-1.6) to 0.3 mmol/l (0.3-0.4), p < 0.05, following treatment with erythropoietin, as did blood lactate concentration at maximal exertion from 2.0 (1.0-4.1) to 1.8 mmol/l (0.5-2.8; p < 0.05). In association with the increase in haemoglobin from a median of 6 (5.1-6.8) to 11.1 g/dl (11-11.9) following erythropoietin therapy, patients were able to achieve greater exercise capacity both in terms of maximum work load and duration of exercise in association with a reduced resting arterial lactate and a similar exercise-induced lactate production. This suggests that treatment had improved muscle function in terms of lactate production and/or utilisation. This was probably due to the increase in tissue oxygen delivery, as there was an increase in the median arterial oxygen content from 79 (65-85) to 150 ml O2 (144-157) following erythropoietin treatment.